MEDICARE: DR. JOHN ROGERS CLAGUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	G3228	TX

General Provider Information

NPI Number	:	1427260074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ROGERS CLAGUE M.D.

Provider Business Mailing Address
First Line	:	610 N HIGH ST
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75652-5914
Country	:	US
Telephone Number	:	903-655-8475
Fax Number	:	903-655-0640

Provider Business Practice Location Address
First Line	:	610 N HIGH ST
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75652-5914
Country	:	US
Telephone Number	:	903-655-8475
Fax Number	:	903-655-0640

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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